Specialty Drug Rebates when Run Through Medical Plan Not RX Plan

[CaliBen]

Any insight on whether sponsors of self-funded health plans are sharing in rebates paid to the TPA when specialty drugs are run through the medical benefit instead the pharmacy program?

We are capturing the rebates paid to the PBM when run through pharmacy benefit. 

[leevena]

Yes, we have groups doing it both ways.  when you say insights, what are you looking for in particular?

[CaliBen]

I'm trying to get an idea of how pricing may change if the TPA passes the rebates through to us instead of keeping the rebates. Trying to gauge whether it is worth it to conduct and RFP.

[leevena]

I looked at one of our groups, just under 3,000 contracts, had a 10% rebate figure, which is where I suspected it would be.  We go back and forth on this, sometimes charging the group a fixed admin cost (such as $8 pepm) or charging nothing.  We leave it up to the group.